تقييم الصحة - نظام الجلد

Health Assessment - Integumentary System

• Integumentary System Components: Skin, hair, and nails.
• Assessment Techniques: Inspection and palpation are the only techniques used to assess the Integumentary System.
• Skin Layers: Epidermis, dermis, and subcutaneous tissue.
• Skin Functions: Sensation, heat regulation, absorption, protection, excretion, secretion, and vitamin D production.

Skin Assessment

• Overall Appearance: Skin assessment begins by observing the overall appearance of the skin.
• Inspection and Palpation: Examine the skin area by area, paying attention to color, moisture, texture, turgor, and temperature.
• Color: Check for uniformity of color and look for bruising, cyanosis, pallor, or erythema.

Color Assessment

• Cyanosis: Look for a dull, dark color in the conjunctivae, palms, soles, buccal mucosa, and tongue.
• Edema: Check the area for decreased color and assess for tightness.
• Erythema: Palpate the area to check for warmth.
• Jaundice: Examine sclerae and hard palate in natural light for a yellow color.
• Pallor: Check sclerae, conjunctiva, buccal mucosa, lips, tongue, nails, palms, and soles for an ashen color.

Pigmentation Assessment

• Petechiae: Check areas with less pigmentation (such as the abdomen) for tiny purplish-red dots.
• Purpura: Hemorrhage into the skin due to low platelet count or liver dysfunction.
• Ecchymosis: Discoloration of the skin (black and blue marks) due to trauma.
• Vitiligo and Albinism: Conditions with insufficient melanin production, causing skin depigmentation .

Moles and Birthmarks

• Changing Moles/Navies: Assess moles for asymmetry, border irregularity, color variation, diameter greater than 1/4 inch, and evolution (changes over time).

Moisture Assessment (B-Moisture)

• Skin Moisture: Skin should be relatively dry with a minimal amount of perspiration.

Texture and Turgor Assessment (C- Texture and Turgor)

• Skin Texture and Mobility: Inspect and palpate the skin's texture, thickness, and mobility. It should look smooth and intact.
• Turgor Assessment: Gently squeeze the skin, noting how quickly it returns to its original shape. Normal turgor means quick return; poor turgor means slow return or tented position.

Temperature Assessment (D-Temperature)

• Palpation: Palpate the skin bilaterally using the dorsal surface of the hands and fingers to assess temperature. Warm skin suggests normal circulation; cool skin may indicate an underlying disorder.

Lesions (Skin Abnormalities)

• Lesion Classification: Primary/secondary, solid/fluid-filled.
• Lesion Characteristics: Symmetry, borders, color, configuration, diameter, and drainage.
• Lesion Shapes: Discoid, annular, target/bull's eye.

Lesion Types

• Pustule: Small, pus-filled lesion (may be follicular).
• Nodule: Raised lesion, palpable, usually greater than 1 cm in diameter.
• Fissure: Painful, crack-like lesion extending at least to the dermis.
• Papule: Solid, raised lesion; usually less than 1 cm in diameter.

Skin Diseases

• Psoriasis: Chronic skin disease with epidermal thickening, symmetrical plaques with silvery scales, commonly on scalp, elbows, and knees.
• Herpes Zoster: Caused by varicella-zoster virus; appears as clustered vesicles or crusted lesions along a nerve root. Commonly unilateral and on the trunk.
• Chickenpox: Common childhood illness causing itchy rash and red spots/blisters (pox).
• Scabies: Caused by tiny mites burrowing under the skin; lesions are itchy and appear in lines on the skin (common locations: between fingers, elbows, knees, groin, abdomen, perianal).

Pressure Ulcers

• Definition: Localized areas of skin breakdown resulting from prolonged pressure.
• Development: Necrotic tissue develops due to diminished vascular supply to the area.
• Staging: Staging reflects the anatomic depth of the exposed tissue.

Hair Abnormalities

• Hair: Formed by keratin from dermal matrix cells in hair follicles.
• Assessment: Note distribution, quantity, texture, and color.
• Common Abnormalities: Alopecia, hirsutism.
• Alopecia: Hair loss.
• Hirsutism: Excessive hair growth in women.

Nail Abnormalities

• Nail Structure: Formed from keratinized epidermal cells.
• Assessment: Color, shape, consistency, and contour are assessed.
• Common Abnormalities: Clubbed fingers, splinter hemorrhages, Muehrcke's lines.